Thoracoabdominal Wall Repair with Glutaraldehyde-Preserved Bovine Pericardium

Abstract

Glutaraldehyde-preserved bovine pericardium (GPBP) is evaluated as a bioprosthesis for the reconstruction of surgical defects in the thoracoabdominal wall. The mechanical properties of bovine pericardium preserved at different concentrations of glutaraldehyde were studied. Samples preserved in 0.5% glutaraldehyde showed a significantly higher tensile strength (11.7 +/- 0.8 N/mm2) than samples preserved in 2.5, 5, or 10% (similar to pericardium preserved in normal saline). The percentage of elongation was significantly lower than samples preserved in 1, 2.5, and 5% glutaraldehyde. GPBP at 0.5% was used to repair experimentally induced defects of the abdominal wall (n = 9), chest wall (n = 6), diaphragm (n = 6), and sternum (n = 7). All animals presented adequate tolerance to the material used and no case of infection or rejection of the material was seen in any of the animals. Finally, 0.5% GPBP was used clinically in a series of 40 patients: postincisional abdominal hernia (n = 30), inguinal hernia (n = 8), diaphragmatic hernia (n = 1), and congenital pelvic defect with prolapse of abdominal organs (n = 1). Surgical use showed that GPBP was a very manageable material and long-term results were good in 37 patients with a mean follow up of 18 months (range 5-35 months). Six patients presented seroma formation (all abdominal hernia patients), three of which eventually developed infection and had the GPBP patch removed at 3, 5, and 7 months postoperatively. The rest of the patients presented good scar formation with adequate resistance at the area of implantation. GPBP is a biological material with sufficient resistance to be used surgically in the repair of thoracoabdominal defects. Ideal concentration of glutaraldehyde to be used in the preparation-preservation of the material is 0.5% since higher concentration negatively affect its tensile rupture strength and elongation.

Comparison of Lyophilized Glutaraldehyde-Preserved Bovine Pericardium with Different Vascular Prostheses for Use as Vocal Cords Implants: Experimental Study

“…LGPBP is readily available, easily prepared, and has low-cost production in comparison with the synthetic materials. Moreover, treatment with glutaraldehyde and lyophilization improves its biochemical stability and reduces its antigenicity, providing good flexibility, easier surgical handling, easier placement, and good integration to biological tissues [ 9 – 13 ]. However, its efficacy and safety as an implant material for VC have not been reported.…”

“…The properties of the LGPBP implants, such as better flexibility, less memory, and ease of cutting, shaping, and sizing for easy insertion and removal from the VC, were a result of the use of fibrous pericardium (the outer layer of the pericardium) formed by laminated collagen fibers. These fibers undergo changes in the primary amines of the lysine and hydroxyproline residues and form inter- and intramolecular cross-links in their chains after being treated with glutaraldehyde [ 21 – 24 ], which improves their biochemical stability (allowing the elastic and collagen fibers to remain well-organized), improves their resistance, allows them to retain their shape, and increases their stiffness [ 9 , 12 , 13 ]. In contrast, synthetic materials tend to curl at the edges because they are formed by rigid amorphous fibers that maintain their memory [ 5 , 6 , 25 ].…”

“…Further cleansing was performed in the laboratory to remove all fatty and connective tissue by dissecting it off the pericardium with clean dry gauze; clean pericardium was further washed with 4°C Hank's solution (SIGMA Chemical Co., St. Louis, MO) in a container with an electromagnetic agitator for 6 h. The pericardium was then mounted on 15 cm diameter plastic frames and submerged in 0.5% glutaraldehyde in 0.1 M phosphate-buffered saline (pH 7.4) at 4°C for at least 15 days before testing. After the initial preservation period, samples were taken from both the preservation solution and the pericardium for microbiological cultures [ 9 – 13 ].…”

“…We have obtained good results using a 0.5% glutaraldehyde solution for preservation and lyophilization (performed to reduce glutaraldehyde residue, facilitating its storage and transport) for the reconstruction of thoracoabdominal wall defects [ 9 ], nonanatomical lung resection [ 10 , 11 ], surgical repair of nasal septal perforations [ 12 ], and closure of atrial septal defects [ 13 ]. In these studies, it has been found that these materials are biocompatible, safe and the cost of its preparation is much less than the cost of synthetic materials [ 9 – 13 ], which is why their use as VC implants may be a good alternative in Mexico. The aim of this study was to compare the use of LGPBP, PTFE, PET, and TF as implants for VC medialization and to assess the endoscopic, macroscopic, and microscopic VC changes after medialization in a canine model.…”

Prosthetics and Techniques in Repair of Animal’s Abdominal Wall

“…However, the percentage of elongation was significantly lower than that obtained in mesh preserved in 1, 2.5, and 5% glutaraldehyde [53]. The tensile strength values of the implanted bovine pericardium decreased in the first month after the implantation, and then they increased again after a decline in the host inflammatory reactions [54].…”